Antibiotic resistance: A major public health challenge

Although Alexander Fleming discovered an antibiotic, namely penicillin in 1928, the first large-scale commercially available antibiotic (sulfonamide) was developed by German Biochemist Gerhard Domagk and marketed in 1945. The "golden era of antibiotics" was from 1940 to 1962 as most of the antibiotic classes that we use today were discovered during this period. 

The discovery of antibiotics radically changed the landscape of medical science. In addition to regular disease treatment, it allowed medical procedures like surgical operations, chemotherapy and many other advanced options to become more available for us. 

But, unfortunately, our good time with antibiotics is running out as they are not performing as well as they used to do. In the medical profession, we coin this phenomenon as "antibiotic resistance." 

We usually use antibiotics to kill particular kinds of bacteria. But if the bacteria manage to survive against an antibiotic, especially designed to terminate it, by evolving their own mechanisms, then we say that the bacteria have gained antibiotic resistance. 

But why do the bacteria do this? The most common reasons are-  limiting uptake of a drug, modification of drug target, drug inactivation through enzymes, active efflux of drug etc. 

As per the data available in multiple sources, there are six major causes behind antibiotic resistance. They are: overusing antibiotics on humans, not finishing the entire antibiotic course, overusing antibiotics in livestock and fish farming, having poor infection control in health care settings, having poor hygiene and sanitation and absence of new antibiotics. 

Global Antibiotic Research and Development Partnership (GARDP) claimed that in the UK, one in five antibiotics are prescribed unnecessarily. In the USA, this number rises to One in three. 

They also revealed that antibiotic-resistant superbugs are responsible for seven lacs deaths per year. Without urgent action, this number is projected to increase exponentially.

Another research estimated that, by 2050, 10 million worldwide deaths could result from antibiotic resistance, making it deadlier than cancer. Meanwhile, 17% of the substandard or falsified medicines reported to the World Health Organisation (WHO) are antibiotics, which has further contributed to drug resistance.

By 2050, 10 million worldwide deaths could result from antibiotic resistance, making it deadlier than cancer. Photo: Reuters

Drug-resistant bacteria can infect anyone irrespective of national or geographical boundaries. And this leads to more hospital stays, increased treatment costs and more preventable deaths. Therefore, antibiotic resistance has been identified by the WHO as one of the biggest threats to global health. 

The World Bank projects that, by 2050, annual global GDP would fall by 1.1% in the low-impact AMR (Antimicrobial resistance) scenario and 3.8% in the high-impact AMR scenario. 

Low-income countries would lose more every year leading up to 2050, with the loss exceeding 5% of GDP in 2050 in the latter scenario. They also estimate that due to AMR, global increases in healthcare costs may range from $300 billion to more than $1 trillion per year by 2050. 

In Bangladesh, the yearly antibiotic consumption in humans is worth around Tk. 3,500 Crore which is the second-largest therapeutic segment in the pharmaceutical industry with a share of 16% of the total market. 

This scenario depicts the extensive usage of antibiotics in Bangladesh. Every year, antibiotic usage is increasing by around 13% to 16% in our country, which is alarming. 

Among different categories of antibiotics, cephalosporins and macrolides are the most used sub-classes with around 50% and 16% share of the antibiotic market respectively. It is worth mentioning that in many cases cephalosporins and macrolides are used as first-line treatment options. 

A study published in the International Journal of Infectious Diseases on Antibiotic resistance in Bangladesh claimed that a high prevalence of resistance was detected in most tested pathogens and many of the first-line drugs were mostly ineffective. 

The above details clearly share the message that the overuse of popular antibiotics is one of the major causes of antibiotic resistance in Bangladesh.   

Every country across the world is concerned regarding antibiotic resistance and raising their voices. WHO also made a global action plan on antimicrobial resistance with five strategic objectives, focused on raising awareness of AMR, strengthening surveillance and research, reducing infection, optimising the usage of antibiotics and ensuring sustainable investment in countering AMR. 

Finally, yet importantly, we need to concentrate on minimising antibiotic resistance in our country. Antibiotics should not be sold without a prescription from a registered physician. Patients should also complete the entire course of antibiotics, even if their symptoms are abated. 

Usage of antibiotics in livestock and fish farming should be made extremely restrictive. Besides, our healthcare providing entities should put utmost effort into maintaining proper hygiene and reducing the number of infections. 

Dr Md Abu Zafor Sadek is a pharmacist at UniMed UniHealth Pharmaceuticals. He also worked as a former short-term consultant at the World Bank, Dhaka. And he can be reached at azs_sohel@yahoo.com

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.